[Anaylsis of the surgeon factor in the treatment results of rhegmatogenous retinal detachment in the "scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study"]

Abstract

Background: The effect of the surgeon on the outcome of surgical treatment for rhegmatogenous retinal detachment (RRD) has previously been analysed in a few studies only. In the prospective multicentre SPR study, scleral buckling (SBS) and primary vitrectomy (PV) were compared in RRD with medium complexity in a randomised fashion. In this study, we examined the surgeon factor on the outcome of RRD surgery within the SPR study.

Material and methods: An analysis of the surgeon as a factor on the functional outcome (logMAR visual acuity), primary anatomic success (retinal reattachment central to the aequator without any additional retina-affecting surgery including laser, cryo and macular pucker surgery) and final anatomic success (retinal reattachment one year postoperatively) was carried out.

Results: Overall, 416 phakic patients (209 SBS, 207 PV) and 265 pseudophakic patients (133 SB, 132 PV) were recruited by 45 surgeons in 25 centres. In the phakic group, the mean functional outcome of individual surgeons was between 0.2 and 0.74 (mean, 0.41, SD 0.41). This difference reached statistical significance (p = 0.0398). In the pseudophakic subgroup, the mean functional outcome was between 0.09 and 0.64 (mean, 0.42, SD 0.49) without reaching a statistical significance (p = 0.0715). Primary success per surgeon varied between 41.67 % and 90.00 % (mean, 63.16 %) in the phakic subgroup and 33.33- 80.95 % (mean, 61.75 %) in the pseudophakic subgroup. Final anatomic success was achieved in 92.86 - 100.00 % (mean, 97.96 %) in the phakic subgroup and 80.00 - 100.00 % (mean, 95.44 %) in the pseudophakic subgroup. There was no statistically significant correlation between surgeon and anatomic outcomes.

Conclusion: In the phakic subgroup, a statistically significant correlation between surgeon and functional success could be demonstrated for RRD with medium complexity. This correlation was not interrelated to the surgical method. Functional outcome in pseudophakic patients and anatomic outcomes in both subgroups of phakic and pseudophakic patients showed no statistically significant correlation between surgeon and anatomic success.